First Nations peoples
Caring for First Nations peoples in general practice
General practice has an important role in providing culturally sensitive services to First Nations peoples. Service provision includes Indigenous health assessments for all age groups and best practice management of chronic disease. The following information enhances the capacity of mainstream general practice to deliver these important services.
1. Prepare the practice
The RACGP Five steps towards excellent Aboriginal and Torres Strait Islander health care (Five Steps resources) will assist you to:
- Register the practice for the Indigenous Health Practice Incentive Payment
- Ensure at least one General Practitioner (GP) and two other staff complete cultural awareness training
- Ensure the practice environment, including the waiting room and reception areas, is welcoming.
2. Identifying patients of First Nations descent
First Nations peoples experience significantly poorer health than that of non-Indigenous Australians and are at higher risk of developing certain chronic disease. Identification of being of First Nations descent ensures health care needs can be appropriately met. Practice staff and GPs can support First Nations patients to self-identify, which is the essential first step in providing specific health services. A patient is considered to be of First Nations descent if they identify as being so. Appearance is not a reliable way of determining cultural identity.
Self-identification is voluntary, but practices must ensure patients can make an informed choice about their decision to self-identify. A patient has the right to choose whether they reveal their ethnic origin. Their answer should be recorded as stated in their patient record.
Routine identification can be assisted through:
- staff cultural awareness training
- improved understanding of the need for and the benefits of health assessments
- culturally appropriate resources in the waiting room
- staff being confident when asking patients their ethnic origin and explaining its importance.
An appropriate way to ask a patient their ethnic origin is:
“Are you of First Nations descent?”
Alternatively, staff may feel more comfortable using a less direct line of questioning, which can then open the conversation for future enquiry. For example:
“Do you identify with a particular cultural background?”
Clinical Audit tool (CAT4)
CAT4 can help you identify patients who are recorded as First Nations and who are eligible for a 715 Health Assessment. Use the link below to view cheat sheets and step by step education videos:
Your clinical software can provide you with reports to help identify patients who are recorded as First Nations or Aboriginal and/or Torres Strait Islander. Use the links below to view cheat sheets:
- Best Practice – using the Best Practice Database SQL search tool, Aboriginal and/or Torres Strait Islander patient lists can be found through Utilities > Search > Demographics > select and add ATSI patient as a search criteria > Click on ‘Run query’ to obtain the list.
Medical Director – using Pracsoft, complete the linked instructions to obtain the Aboriginal and/or Torres Strait Islander patient list.
3. First Nations health checks
Early indications are that the Medicare Aboriginal and Torres Strait Islander health assessments have the potential to considerably reduce morbidity and mortality. Early detection, diagnosis and intervention of common, treatable conditions will reduce the disproportionately high rate of late presentation, diagnosis and hospitalisation amongst Indigenous Australians.
The third edition of the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (National Guide) is a joint initiative of the National Aboriginal Community Controlled Health Organisation (NACCHO) and The Royal Australian College of General Practitioners (RACGP).
The purpose of the National Guide is to provide health professionals with an accessible, user-friendly guide to best practice in preventive health care for First Nations patients.
- NACCHO National guide to a Preventative Health Assessment in Aboriginal and Torres Strait Islander peoples.
4. Register eligible patients for the Indigenous Health Practice Incentives Program (PIP) and the Closing the Gap PBS co-payment
The Practice Incentives Program (PIP) Indigenous Health Incentive aims to support general practices and First Nations medical services to provide a comprehensive range of health services for First Nations patients, including best practice management of chronic disease. Financial incentives are arranged into 3 components that are based upon the level of care provided.
- Your guide to Medicare for Indigenous health services
- Indigenous Health Incentive guidelines (Medicare Practice Incentive Program)
- Medicare Practice Incentives Programs website
Use this form to register an eligible First Nations patient in the PIP Indigenous Health Incentive or the Pharmaceutical Benefits Scheme (PBS) Co-payment measures:
Use this form to register multiple eligible Indigenous patients in the PIP Indigenous Health Incentive or the Pharmaceutical Benefits Scheme (PBS) Co-payment measure:
Cultural awareness training PIP requirement
A requirement of the PIP Indigenous Health Incentive is that at least two staff members of your practice (minimum one GP) require cultural awareness training within 12 months of the practice signing onto the PIP.
The Royal Australian College of General Practitioners (RACGP) offer a 6-hour online Active Learning Module (ALM) that helps participants to:
- extend their knowledge about First Nations history and culture
- explore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical setting, and
- discuss key ways the practice team can be more culturally aware.
Alternatively, the Institute for Urban Indigenous Health (IUIH) Integrated Team Care will deliver free cultural awareness training to your general practice. Visit the Brisbane South PHN education calendar to view any upcoming events.
5. Use appropriate clinical guidance and programs from the RACGP, Medicare and PHNs to enhance access and quality of care
- Brisbane South PHN Patient Population Quality Improvement Toolkit – This QI toolkit will assist your practice to identify First Nations patients in your practice, identify those eligible for PIP and PBS co-payment, review available MBS items and immunisation schedule.
- Queensland Health Deadly Ears Program includes information for health professionals in primary care.
- Ear and Hearing Health Check Queensland Health iLearn
- Commonwealth Department of Health Program – Care for Kids Ears has resources and information for health professionals. Ears are checked as part of conducting the First Nations health check—MBS items 715 and 228.
- Department of Health Clinical Care Guidelines – Recommendations for Clinical Care Guidelines on the Management of Otitis Media (Middle Ear Infection) in First Nations Populations 2010.
- Department of Human Services Education guide – Aboriginal and Torres Strait Islander health assessments and follow-up services
- Department of Human Services Indigenous Access Program for health professionals
For information on other initiatives supported by Brisbane South PHN please visit our First Nations health page.